It is a well known fact in the medical and pharmaceutical fields that the hazards of noncompliance among patients responsible for their own medication regimen have attained alarming levels with far reaching effects.
It has long been felt that patient instruction and education on the importance of drug compliance and the therapeutic benefits accruing to the patient would decrease the level of errors and enhance patient performance in this area. At a recent major symposium on drug compliance sponsored by the National Pharmaceutical Council, clinical reports make it clear that such is not the case. One research study reports:
". . . one would expect the IQ and educational level of the patient, as well as his or her knowledge of the disease and its treatment to affect compliance. The evidence suggests otherwise: 70% of the studies found no such relationship." PA1 "Noncompliance with medication regimens is emerging as a major public health problem. Noncompliance can take the form of underuse, overuse, or erratic use of prescribed medicines. At least one of every three prescriptions dispensed in the United States is taken incorrectly. PA1 Researchers have documented the extent and causes of noncompliance and have indicated possible remedies. Nevertheless, medical practitioners, insurers, and consumers generally underestimate the negative impact of noncompliance. Not only does noncompliance adversely affect public health, it also results in increased utilization of costly medical services."
Patient instruction for short term (less than one month) medical treatments has been shown to have some benefits but has no lasting effect on long term compliance.
Most researchers and clinicians agree that the level of noncompliance has been shown to be about 40%--and reaching 50% or more with long-term chronic patients. This means that at least with 40% of the prescriptions written, there is overuse, underuse and misuse and the patient is not benefiting fully from the intended efficacy of the drug. In fact, life-threatening circumstances may arise instead.
In this regard it has been reported that in the United States 125,000 heart and hypertensive patients die prematurely each year due to noncompliance with their medication regimen.
Not only the health hazards but also the economic effects resulting from noncompliance are astronomical if one considers all the factors. One researcher (McDaniel et al 1982) checked on 7 patients identified as noncompliers by their physicians and discovered that for just this small number there were direct costs incurred of more than $14,000. These included outpatient visits, emergency room visits and hospital days, directly attributable to noncompliance over a 12-month period. These costs do not include loss of man hours on the job or financial stresses in the home.
It is estimated that 1.8 billion prescriptions are filled annually in the United States. Statistics indicate that at least 720,000,000 of these prescriptions are used incorrectly by the patient. The implications of this in a medical, health-care sense are staggering apart from the enormous economic waste involved on an international scale.
Mark R. Knowles, President, National Pharmaceutical Council states: